Relevant calcified coronary artery disease (CCAD) may be present in around 20% of patients undergoing percutaneous coronary interventions, and it is known to add procedural challenges and risks. Careful patient selection and specific expertise in multimodality imaging and plaque modification techniques are required to plan and adopt the most appropriate therapeutic strategy. This review aims to present the contemporary clinical approach and procedural planning for CCAD patients, describing the available tools and strategies in view of the most recent scientific evidence.